Expanding the Scope of Veterans' Healthcare

Debates over public policies are frequently carried out under a false assumption that complex problems require complex solutions. And many of today's big questions are approached as if the simple answers will never suffice. This attitude dominates much of the most important debates playing out today, from healthcare to taxes to immigration to education and many others. The problem, however, is that this oftentimes obscures the most direct, straightforward solutions.

This same situation is playing itself out in how policymakers respond to the issue of providing higher quality healthcare in a more timely fashion to veterans across the country. There is little doubt that the issues facing the Veterans Health Administration (VHA) are complex. It is the largest healthcare system in the country — 1,700 facilities across 50 states and several territories — serving millions of veterans each year.

However, expanding the VHA's ability to better serve those seeking care may not necessarily require some complicated approach, or even an increase in budgets or staff. It may be as simple as removing barriers and allowing providers within the VHA system to practice to full extent of their education, training and certification.

This past month, a bipartisan group of senators introduced legislation that would empower advanced practice registered nurses — such as nurse anesthetists and nurse practitioners, and physician assistants — to practice to the fullest scope recommended by their respective professional organizations. This would apply to all VHA facilities regardless of the state-level restrictions that are in place. By giving these providers this autonomy, the VHA's ability to treat the backlog of veterans seeking care would immediately improve without the need to spend one additional penny. More importantly, it could drive the conversation surrounding the future of healthcare in America.

In 29 states, state-level scope-of-practice laws limit what nurses, nurse practitioners, physicians' assistants and other providers may do in the course of caring for patients. As my colleague Matthew Mitchell explains, this is a contributing factor behind the failure of our health system to meet demands of a growing and aging population. He and his coauthors note, "By restraining the supply of medical services, scope-of-practice laws have contributed to the shortage in primary care givers."

If full practice rights were given to these providers at VHA facilities, it would essentially create a class of nearly 800 “health care opportunity zones” across the country. This is how it would work: If the scope of practice were expanded at these providers, it would take effect regardless of state-level restrictions. The federal directive would preempt any state laws. It would only apply, however, at these facilities. As a result, at nearly 800 VHA facilities across the 29 states that have scope-of-practice restrictions, providers would be given greater freedom of practice and patients would be given more options than what's available throughout the rest of the state. These facilities could become islands of empowerment amid seas of restrictions.

But how would this change the delivery of healthcare in America? For routine and ongoing care needs, a recent study found no difference in the quality of care provided by physicians and nurse practitioners. The one difference that the study did find, however, is that patients seeing nurse practitioners had higher levels of satisfaction with their care. In short, it would do little to change the quality of care but would lead to marked improvements in satisfaction. This is why both the Institute of Medicine and the Federal Trade Commission have both advocated against scope of practice restrictions.

Ultimately, expanding the scope of practice within VHA facilitates would put the VA in a position of being a policy innovator. It would certainly be a role reversal for an organization characterized by recent scandals, and could push many states to reevaluate their own restrictions on the provision of health care. After all, state governments are struggling with the same issue of how to increase access for those in most need of care.

The future of health care is a complex discussion, but how we arrive at that future doesn't have to be. Sometimes the simplest solutions are the most profound. And beginning to solve the shortages in healthcare could be as straightforward as removing the artificial restraints that hold back professionals from delivering the care they are trained to provide.